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-. <br />APPLICAiI�.�rl FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING OIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTIOIi ❑ COMBIHATION 0 BUILDINO ❑ IAECHANICAL ❑ pLUMBING ❑ SI(iN <br />PROJECTADDRESS: 1')�O � ��'n,aiv� <br />GTY <br />MCM�ECTOROESIGNER IMtt�ODNE55 C11Y 71P p�E <br />CENERKCONTMCTOii NUL�OpN[55 CIfY 7iP MqNE GfeTEUCENg• <br />ME�M�MC�ItOMiR�LTOfi M/Y11100R(55 CITV IIF PHONE iT�TE LICENSE • <br />RUYlRIGCONTR/iCtOR 4MlA0DRE55 CItY ZIP PNONE ST�fEL1LEN5E1 <br />DESCIME t10111(111U SOU�RE FOOT/y�MVOLVEO <br />_ �i�JSF tt o+a osr � <br />_!—>>o,t 1-v . ti S ,�,� <br />rroroseo us¢ oF euidr/o <br />1Ed40E OFP110PERTY151qMMlELON <br />�oT -�xocu .�i'�_ or_ <br />/�r//� -JZ.S = OZ% <br />PMICEL TNI I D. M11AlER <br />CONSTRlICT10N ldW lEN0EH.110011E55. 7ELEP110 <br />PLUMSM/0 <br />NO• TYPE OF FlIITURE OR I' <br />WATER CLOSET ROILETI <br />--_� URINAL <br />SU8 <br />FOR OFFICE USE ONLY: <br />FRONTSETBi1Ck i1E�R5ETMCK <br />�v <�O <br />USE Z <br />�" � <br />/IEI6NT LIMIAI�ION <br />00 <br />LOI�RE� <br />ra a owewrw <br />UNIfS <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CT PERSpN N1p P��p� �q /� <br />_ /LiiSi la� .. �'si �' e�l�tl, <br />� ji4 ,��,,.V I HEREBV CERTIFY THAT I HAVE REAO AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORNECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINC THIS TYPE OF <br />WORK WILI BE CAMPLIE� WITH VYFIETMER SPECIFIED HEREIN OR <br />a+at N, cov�sl NpT. THE ORANTINO OF A PERMIT ppES NOT PRESUME TO OIVE <br />THORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR IOCAL LAW RE6UUTINO CpNSTRUCTION OR THE <br />� PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTMOpIZED BY TME <br />OWNER OF THIS PqOPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 298200 WqC, <br />��R x � ��� �"��'S�i <br />SIGN�T� DI1TE <br />FEE f � <br />SIOE SETB�CK <br />� <br />�l <br />V�C�NT SIfE <br />❑YES ��NO <br />sze or e�ocrti <br />B�SE/AENT I� <br />OYES �ip <br />p7Y BU9NE55 LICENSE N0. <br />IVC —l1� <br />FORCED <br />METAL FIREPLACE <br />FIREPLACE INSERI <br />GAS FIREPIACE <br />GASRANGE <br />GAS PIPING <br />PUN CIIECk NUMpER <br />Sar�o�- <br />BNLbM6 <br />PLUMBING <br />MECN�HIC�L <br />�O�i110NAL P111N GNCCK <br />OINER <br />ST�TE BIIIIOMf, SU�LNeOGE <br />CITY OF EVERETT �Upl If. WORKS <br />LOCALSALES <br />TAX CODE IS �105 To7�� <br />)TAl S <br />f f <br />FEE f <br />REf.EIPf NO <br />FEE <br />�� <br />_, n <br />